Psychologist Charmaka Newton, who practices his own practice in Lansing, Michigan, is passionate about serving black and Hispanic patients. They often look for therapists who understand how their race, ethnicity and culture affect them, she said, and she helps to provide that care.

Medicaid is Major Healthcare Sources For people of color. However, Newton can afford to look at a small number of Medicaid patients because the program is far less than commercial insurance.

Congressional Republicans are looking to significantly reduce Medicaid. Medicaid aims to cover a joint federal national health insurance program that covers a total of 72 million low-income and people with disabilities, or one in five in the United States. If that happens, Newton and many other mental health providers are worried that the already low Medicaid reimbursement rate will stagnate or even decrease.

That would make it difficult for her to continue watching Medicaid patients.

Medicaid cuts, the most likely, will be hit hardest in rural areas

“Medicaid is probably one of the most difficult insurance policies to work with,” Newton told Stateline. “If a cut occurs, my biggest fear is that individuals don’t have access to providers that can help them.”

There is already a shortage of mental health care providers. Approximately 122 million people, or about 35% of the US population, live in areas with a shortage of mental health care professionals. Data from Federal Health Resources and Services Management. If Medicaid reimbursement rates drop and more providers refuse to see those patients, the shortage will be exacerbated.

Nationally, Medicaid covers nearly one in three working-age adults living with mental illness. 15 million adultsaccording to the Health Policy Research Institute KFF.

The US Energy and Commerce Committee, which oversees Medicaid, is looking for at least $880 billion in budget savings over the next decade, primarily to pay for the large-scale tax cuts. March 5th letter The Congressional Budget Office, the nonpartisan research arm of Congress, confirmed that the cuts in size must come from either Medicaid or Medicare, an insurance program aimed at seniors.

President Donald Trump says Medicaid is leaving because Medicare is off the table.

The lawmakers are considering it Many optionsIncludes reducing the federal percentage of costs covering new eligible people in Medicaid under the Affordable Care Act. If that happens, a state that chooses to expand to cover those residents – adults with incomes up to 138% of federal poverty levels – will need to increase their spending or find savings elsewhere.

That could mean removing some people from Medicaid roles, eliminating coverage for certain services, or reducing refund rates.

“These [actions] Gillaspy told Stateline. “Now everyone is holding pins and needles for potential cuts.”

Interstate variations and various challenges

In at least 15 states, more than 40% of Medicaid people reported experiencing mental illness. KFF analysis Research data from the Federal Department of Substance Abuse and Mental Health Services for 2021-2022.

Congressional Republicans are still blaming whether or not they are cutting Medicaid. Chris Pope, a senior fellow at the conservative policy group The Manhattan Institute, suspects Stateline will be affected by mental health services or reimbursement rates.

“From a financial standpoint, mental health is basically a bucket drop, not where you need to save large amounts,” the Pope said.

Medicaid reimbursement rates for mental health services vary dramatically from state to state. Refunds for an hourly individual psychotherapy session ranged between $95 and $135 in 2022. 2023 Research Featured in Journal Health Affairs.

State generally have the flexibility to set a doctor’s reimbursement rate. So they can do that, “if the state has the money to increase the refund rate,” the Pope pointed out. And many states did that. According to January 2023 KFF Reportalmost two-thirds of the 44 states that responded to the survey said that in 2022 it will increase the planned 2023 behavioral health rebate rates for Medicaid enrollees.

Oregon passed the bill during the 2022 session increase Medicaid Behavioral Health in the State Refund rate To address the challenges of the mental health care workforce, by an average of 30% of providers looking primarily at Medicaid patients. In 2022, the state Fourth highest rate For unmet needs of mental health treatment nationwide. Currently, the state has one of the highest refund rates.

“In Oregon, they’re actually really committed to paying providers well and providing cost-of-living updates, which makes them much more appealing to providers who provide Medicaid services,” Jen Yerty, a licensed counselor in Portland, Oregon, told Stateline. Yerty, however, said higher reimbursement rates are the lowest to get the providers interested. She said she helps clients help clients with case management, including helping them access social services and rental assistance.

“If they actually refund us more for all the case management we do, that’s great. If they provide more resources, that’s great,” Yerty said.

However, behavioral health services such as psychological tests to assess mental health functions are Medicaid services needed by the federal governmentso that primary care doctors come to visit.

Giraspie of the American Psychological Association noted that the levels of services offered statewide are also different. And case management and psychological testing are exactly the kind of services that could be found in the chopping block, he said, as the state considers cuts.

What the state did

KFF researcher I’ll point it out Four main ways are trying to address the mental health workforce shortages in the state’s Medicaid program. These include increasing reimbursement rates, reducing provider management burdens, and creating licensing compacts to allow providers to work across state lines, reducing licensing requirements, and promptly reimburse providers to encourage participation.

Megan Cole, an associate professor of health policy at Boston University, told Stateline that there are other options the state can pursue, such as offsetting federal cuts and increasing taxes to maintain reimbursement rates. She also said Medicaid could ask primary care providers to begin preventive mental health screening and integration of services before care becomes acute, requiring emergency room visits.

“There are models of care that work well in this area, and not all states are implementing them now, so I think there are plenty of opportunities to expand on some of these integrated care models,” Cole said.

Another option she recommends is for the state to invest in community health centers. Many Medicaid patients look at mental health providers.

Investing in public health facilities is also what Michigan Republican Rep. Phil Greene wanted. Invoices were co-repeated In 2023, we joined democratic lawmakers to increase the reimbursement rates for community behavioral health clinics. However, he said the bill likely died last year.

Green told Stateline that mental health issues are bipartisan issues. Green says his Caucus lawmakers, including some veterans, are well aware that mental health issues are a major concern within the population. “Republicans and conservatives alike recognize this as an increasing issue and an increasing need.”

He believes that if the federal government cuts its contribution to Medicaid, state Republican lawmakers will still be interested in finding some solutions to the shortage of mental health care workers.

California, 2023 state Implemented changes To improve reimbursements for Medicaid Mental Health and Substance Use Disorder Services providers through the county’s behavioral health department. The goal of this effort was to remove some of the common problems faced by providers. For example, it includes refunds and long delays in the long audit process.

David Hindman, former president of the California Psychological Association, said the most important effect is to increase the reimbursement rate to meet the increased costs of providing care to Medicaid recipients. Hindman works for the Los Angeles County Public Health Department, but he said he is not allowed to speak on behalf of the department.

“We’ve actually expanded our services a lot,” says Hindman. “Learning low-income patients is a fully incentive provider institution. It covers a lot more.”

Still, the clinicians who don’t work through the county health department, who see many Medicaid patients still struggling to achieve their goals, said. And he says the state still has to explore solutions to the workforce shortage in the face of major federal funding cuts.

Editor’s Note: This story has been updated to clarify the title of Charmeka Newton. You can access Stateline Reporter Shalina Chatlani [email protected].

(Stateline) It is a nonprofit news network that is part of the state newsroom and supports a coalition of grants and donors as a public charity of 501C(3). Stateline maintains editorial independence. For questions, please contact editor Scott S. Greenberger. [email protected]. )